Newsletters

Therapeutic Lifestyle Change

Friday, May 1, 2015 - 14:30

Fitness and healthcare professionals are often dependent on anthropometric measurements (body fat percentage) and laboratory test results when evaluating the effectiveness of interventions such as cholesterol-lowering (statin) drug therapy, or changes in diet or exercise. The problem with this standard way of measuring success is that small improvements which appear less than spectacular can clinically be quite beneficial. Modest lifestyle changes reduce cardiometabolic disease risk and, more importantly, improve quality of life well beyond their influence on conventional laboratory measurements.

In one of the most important lifestyle trials conducted, after more than three years in the lifestyle stream of the Diabetes Prevention Program (DPP), participants lost just 8.8 pounds on average, or about 4.5 percent of their body weight. Despite this modest weight loss, new onset diabetes was reduced 58 percent compared with 31 percent among those taking Metformin (a diabetes drug). Even better, those over age 60 reduced their diabetes risk by more than 70 percent! These outcomes were achieved with very small dietary interventions and weekly exercise totalling approximately 1000 calories burned. This was also shown to be the case in a 20-year follow-up analysis of the Da Qing Chinese Diabetes Prevention Study, in which participants also made very modest changes in blood lipids and body weight.

Most studies also show improved arterial endothelial function with exercise training. Endothelial dysfunction (inability of the arteries to sufficiently dilate and contract) contributes to the initiation and progression of atherosclerotic disease – improved endothelial function is thought to be one of the primary mechanisms responsible for reduced cardiovascular disease morbidity and mortality. Both aerobic and resistance training improve insulin sensitivity and glucose transport mechanisms, which reduces the risk of diabetes and cardiac disease. Dietary elements such as Omega-3 fatty acids, walnuts, and olive oil have also been shown to significantly improve endothelial function, as well as reduce elevated triglycerides after a fat-rich meal.

In one of the most noted clinical exercise science reviews recently published, Richard Telford, renowned physiologist at the University of Melbourne, revealed that the scientific literature consistently indicates a strong association between low physical activity and mortality and mobidity associated with type 2 diabetes. This was after controlling for obesity and other potentially confounding variables. In plain language, this means that it is possible to reduce the risk of dying from diseases of lifestyle (heart disease, diabetes, and so forth) by making healthy changes that do not necessarily lead to weight loss.

Reference:

Exercise Specialist Recommendations:

Incorporate weekly exercise that totals 1000 calories burned. This is equivalent to about 3 hours of walking. Work up to 1500 calories burned per week (4.5 hours) – this is ideal for disease prevention.

Use a pedometer and try to take 10,000 steps per day.

Adopt as much of the Mediterranean diet as possible – add in nuts, legumes, whole grains, fresh fruit, vegetables, fish and olive oil. Make small, gradual dietary changes over the course of 6-12 months.

Walk or bike anywhere that will take 45 minutes or less – incorporate physical activity into your daily life and make it utilitarian. Take the car as a last resort!

Take stairs whenever this is an option.

Exercise and Type 2 Diabetes – Risk Reduction and Improved Outcomes

Sunday, March 1, 2015 - 14:30

Performing a combination of aerobic exercise and resistance training was associated with improved glycemic levels among patients with type 2 diabetes, compared to patients who did not exercise, according to a study in the November 24 issue of Journal of the American Medical Association. The level of improvement was not seen among patients who performed either aerobic exercise or resistance training alone. Although it is unanimously accepted that regular exercise provides substantial health benefits for individuals with type 2 diabetes, the exact exercise type (aerobic vs. resistance vs. both) has been unclear. “Given that the 2008 Federal Physical Activity Guidelines recommend aerobic exercise in combination with resistance training, the unanswered question as to whether for a given amount of time the combination of aerobic and resistance exercise is better than either alone has significant clinical and public health importance,” the authors write.

Timothy S. Church, MD, MPH, of Louisiana State University and colleagues conducted the HART-D trial, which compared among 262 sedentary women and men with type 2 diabetes the effect of aerobic training, resistance training, and a combination of both on change in hemoglobin A1c levels (HbA1c). HbA1c is a minor component of hemoglobin - the part of red blood cells that carries oxygen to the cells - and to which glucose is bound. (HbA1c levels are used to monitor the control of diabetes mellitus). The individuals were enrolled in the 9-month exercise program between April 2007 and August 2009. Forty-one participants were assigned to the non-exercise control group; 73 to resistance training sessions; 72 to aerobic exercise sessions; and 76 to combined aerobic and resistance training.

The researchers found that the absolute change in HbA1c in the combination training group vs. the control group was -0.34 percent. The resistance training group posted an average change of -0.16 percent, and the aerobic group a change of -0.24 percent. By far, the combined group saw the most significant change in HbA1c compared with those in the control group. Over the course of the exercise program, medication usage to manage blood sugar increased by 39 percent in the control group, 32 percent in the resistance training, 22 percent in the aerobic, and 18 percent in the combination training groups.

“The primary finding from this randomized, controlled exercise trial involving individuals with type 2 diabetes is that although both resistance and aerobic training provide benefits, only the combination of the two were associated with reductions in HbA1c levels,” the researchers write. “It also is important to appreciate that the follow-up difference in HbA1c between the combination training group and the control group occurred even though the control group had increased its use of diabetes medications while the combination training group decreased its diabetes medication uses.”

Ronald J. Sigal, MD, MPH, of the University of Calgary in Alberta, and Glen P. Kenny, Ph.D., of the University of Ottawa and Ottawa Hospital Research Institute, Ottawa, write in an accompanying editorial that this study provides important evidence on the effects of aerobic and resistance training on improving hemoglobin HbA1c levels. “Based on the results of the HART-D trial, patients with type 2 diabetes who wish to maximize the effects of exercise on their glycemic control should perform both aerobic and resistance exercise. [This] clarifies that, given a specific amount of time to invest…it is more beneficial to devote some time to each form of exercise rather than devoting all the time to just one form of exercise.”

Reference:

Preventing Shin Splints

Sunday, February 1, 2015 - 14:30

What Is It?

Finally the weather is improving and you decide to capitalize on the warming days by getting out for a couple of long walks, and – ouch! Most long distance runners are aware of a common injury called Shin Splint Syndrome, referred to colloquially as “shin splints”. Shin splints, however, is also common among recreational walkers. This condition is characterized by pain in the front of the lower leg, which can run from below the kneecap all the way down to the ankle. It accounts for 10-15% of all running injures, and up to 60% of the conditions that cause pain in the lower leg. The lower leg is the initial shock absorber during impact exercise – if this shock-absorption system begins to fail, you may experience a sore, tingling sensation that can be mild to debilitating. While runners hit the ground at approximately three times their body weight, walkers also experience impact – 1.2 times their body weight with each foot strike.

Treating Shin Splints

If pain is severe, a medical specialist should be consulted first to rule out a stress fracture in the lower leg bones, which are called the tibia and fibula. That being said, the crucial first step in treating shin splints is identifying the root cause of the problem. There are many possibilities including sudden changes to your exercise routine, poor ankle flexibility, poor muscle tone in front lower leg muscles, training errors, and structural problems like over-pronation or flat feet. But don’t fret – there are many possible strategies for preventing or overcoming shin splints.

Exercise Specialist Recommendations:

Increase distance slowly. This is a concept in exercise physiology called gradual progression. Even though sunlight is streaming down through the trees and the air is heavy with the sweet smell of spring, do not throw caution to the wind and walk two or more hours that day if you have not walked more than 30 minutes all winter. It is very possible that your lower leg muscles will rebel. There is no magic rule for adding time onto a walk or run – this varies depending on fitness level, current and recent past exercise volume, and presenting health conditions. For most individuals, adding between 5 and 10 minutes per walk, each week, is sufficiently prudent. For example, the first week you can walk five times for 25 minutes, the next week five times for 30 minutes, and so on.

Stretch your calves. If your calf muscles are flexible your ankle will have more mobility, which makes for a more efficient shock absorption system. Make sure to stretch both your gastrocnemious and your soleus, by letting your heel drop off a step (sticking your butt out will give you a better stretch). Start with a straight leg, then bend your knee to feel a deeper stretch closer to your Achilles tendon. The added bonus of stretching your calves off a step is that you stretch the plantar fascia on the bottom of the foot as well.

Strengthen the front of the lower leg. This is very simple – just lean back again a wall and lift your toes up toward the ceiling, then lower slowly. This can be done with or without weights – lighter individuals may want to hold dumbbells to add some resistance. Build up to 20 repetitions. The speed of the reps can be varied to train for both strength and endurance. (Executing quick reps with heavy weights is not recommended.) Only train for endurance once all pain has disappeared and a base of strength has been developed.

Take care when changing your training environment. If you use a treadmill during the winter months then switch to walking outside on concrete sidewalks in the nicer weather, make the transition a gradual one. Exchange one treadmill walk with outdoor walking, then two, and so forth. Once you are walking outside exclusively, once again use gradual progression to build up your time. If you hike, use these same training principles because walking on uneven terrain can cause shin splints.

Evaluate your walking technique. Working with a professional can give you information on how you might change or improve your gait.

Don’t disregard possible structural issues. People with flat feet or fallen arches are especially prone to shin splints. If this sounds like you, taking great care to choose the right shoes, as well as considering custom made orthodics, can correct issues that cannot be addressed by exercise programming alone.

Enjoy your walk! Enjoy your run!

It’s NEAT: Burn Calories without Exercise

Thursday, January 1, 2015 - 14:30

As obesity in both children and adults continues to be a serious personal and public health issue, the need to recognize all contributing factors becomes even more important. An inactive lifestyle and low levels of structured exercise, coupled with excessive food intake, are commonalities observed among a majority of overweight/obese individuals. Over the last decade, an innovative field of study has developed which looks how activities of daily living, called non-exercise activity thermogenesis (NEAT) impact on weight gain and obesity. NEAT is the energy expenditure that occurs during daily activities that are not considered planned exercise, including of standing, walking, talking, and fidgeting. This body of literature grew from the observation that people who fidget and move around a lot in their everyday lives – individuals who “can’t seem to sit still” – tend to not be overweight.

In a 2005 study, researchers recruited 20 healthy volunteers who had one very similar description of their planned physical activity – they did none. They were self-proclaimed “couch potatoes”. Of the 20 volunteers, 10 were classified as lean on the Body Mass Index scale, and 10 were classified as mildly obese. The authors selected mildly obese subjects because this group is less likely to have medical impediments and orthopaedic issues than the morbidly obese. Each individual wore an inclinometer and triaxial accelerometer, sensitive monitoring devices that capture data on body position through all planes of movement 120 times per minute. With this equipment, the authors were able to capture data every half-second for 10 days, leading to an incredible final collection of 25 million data points on movement and posture for each subject after the 10-day experiment was completed.

The results were striking: the obese subjects were seated for 164 minutes longer each day than the lean subjects. In addition, the lean participants were upright for 152 minutes longer per day than the obese subjects. Sleep times between the groups did not vary at all. In essence, the energy expenditure generated by the lean individuals’ extra movement averaged 352 calories per day, which is equivalent to approximately 36.5 pounds per year.

Exercise Specialist Recommendations:

Always take the stairs, no matter how many flights are entailed!

If you must take an escalator, walk up the stairs instead of standing still.

Walk everywhere you can.

Take frequent breaks from computer time to use the washroom, make tea, or find something you need.

Get a standing desk.

Walk around while talking on the phone.

Clean up your house often!

Get a dog and walk it every day.

Borrow a friend’s dog and walk it every day.

Wear comfortable shoes to work that do not inhibit movement.

Set your phone to remind you to stand up and stretch every half hour.

The possibilities are endless. Keep moving!

Inactivity Physiology

Monday, December 1, 2014 - 14:30

Most of us are familiar with the benefits of physical activity. A reduction in the risk of cardiovascular disease, diabetes, low back pain, osteoarthritis, anxiety and depression, and even some forms of cancer can be counted among the myriad advantages of leading an active life. However, what is lesser known is the flip side of this – the damaging effect of an inactive lifestyle, which includes sitting all day at work, and lying on the couch in the evening. The relatively new area of research is aptly called “inactivity physiology”, and recent findings shed an uncomfortable light on the manner in which more people in the Western world live.

The average person now spends 9.3 hours a day sitting. People who sit for six or more hours per day are 40 percent more likely to die within 15 years compared to someone who sits less than three hours a day – even if they exercise. That is to say, that even if you are getting the American College of Sports Medicine (ACSM) recommended amount of physical activity, you still fall into this category. The excessive sitting behaviour effectively cancels out the benefit of the daily exercise. Obese people sit 2.5 hours more each day then people of normal weight. Among the 7278 men and 9735 women enrolled in the Canadian Physical Activity Longitudinal Study, there was a strong association between sitting and mortality risk from CVD and all other causes, after adjusting the data for potential confounding variables (eg, age, sex, smoking status, alcohol consumption, leisure time, and physical activity). The highest mortality subpopulation group is obese men and women who spend most of their waking time sitting.

Studies of sedentary behaviour suggest that sitting for extended periods of time increase a person’s chances of developing a wide range of illnesses and diseases, including several types of cancer, cardiovascular disease, obesity, and Type II diabetes. In a recently published study, Dr. Christine Friedenreich, a senior epidemiologist at the Alberta Health Services, found that high levels of physical activity reduced the risk of breast and colon cancers by up to 30 percent, reduced the risk of prostate cancer about 10 to 20 percent, and reduced the risk of endometrial cancer between 30 and 35 percent. However, the most disquieting result of her study was that people who job for half an hour in the morning and then sit at a desk all day may be no better off then those who don’t go running.

Why might this be? There are few definitive answers as this is an emerging area of research, but current knowledge points to several possible factors:

In animal studies with rats, it has been found that when they are not allowed to stand there is a dramatic drop in lipoprotein lipase, the enzyme in the leg muscles that captures fat out of the blood to be used by the body as fuel. Thus, with consistent sitting, blood triglyceride levels start to soar which increases the risk of CVD. It has been hypothesized that this same process occurs in humans.

A clinically relevant decrease in HDL (“good”) cholesterol is observed with regular, prolonged periods of sitting.

Exercise Specialist Recommendations

Stand up and walk around your office every 30 minutes.

Set a timer on your computer or smart phone to remind you to get up regularly.

Stand up and get some water.

Walk to your colleagues offices instead of emailing them.

Walk to the farthest bathroom in your workplace (if more than one is available).

Always stand and walk around the room when on the phone.

Take a 5-minutes walk break with every coffee break.

At night when watching tv, take breaks during commercials to do standing stretches or some easy leg exercises.

Stand up while watching tv to do single leg balances.

Capitalize on Non-Exercise Activity Thermogenesis (NEAT) – in a nutshell, it has been found that people who tend to fidget and move around spontaneously throughout the day have lower levels of obesity, because they burn more calories than their sedentary counterparts

The bottom line is that it is necessary to incorporate as much movement into our daily lives as possible, in addition to a scheduled exercise program.

Fitness and Aging – Use It Or Lose It

Friday, November 1, 2013 - 14:45

Alex Hutchinson, who writes the Jockology column for the Globe and Mail, published a wonderful piece several months ago that addressed the perennial question of whether we exercise less as we get older because our bodies start to break down, or if our bodies break down because we become less active as we age. For years, it was widely accepted that humans start to get weaker starting in their 30s. However, new research on topics ranging from the cellular mechanisms of aging to the time-defying performances of masters athletes are forcing investigators to question this assumption. It appear that the first signs of decline are more a function of lifestyle than DNA – if you keep using it, you will be well into middle age before you start losing it.

One of the classic approaches to studying age-related decline is to look at how age-group records change in sports such as running or weightlifting. The fastest and strongest 45 year olds are considerably slower and weaker than their 25 year old counterparts. However, there are several problems with this line of reasoning, the most important being that even the best older athletes train less as they age. The reasons for this are unclear – is it because these athletes give up on hard workouts because they are not going to make the Olympics, or is it because those hard workouts hurt more than they used to? Another problem with looking at age-group records is that extreme levels of performance require a punishing training regimen that can rarely be sustained longer than 10 years. Most athletes setting records in their 20s are not training at a high level in their 40s for this reason.

To counteract these research problems, scientists at the German Sport University Cologne looked at the times of mid-pack (average) runners, since their time is more likely to be consistent over several decades. To do this, the researchers evaluated finishing time data for more than 900,000 marathon and half-marathon finishers in German races, ranging in age from 20 to 79.

The results were startling: No significant age-related decline in performance appeared before the age of 55. And even beyond that age, the decline was surprisingly gentle – in the 65 to 69 group, a full 25 percent of the runners had times that would have ranked as above average among 20 to 54 year olds. The most important thing to note is that all the runners in the study trained a similar amount – three to four times per week for about an hour – no matter what their age.

The conclusion, according to the researchers, is clear: “Performance losses in middle age are mainly due to a sedentary lifestyle rather than biological aging.”

Exercise Specialist Recommendations:

Run, walk or cycle three to four times per week for an hour!

Fit walking into your daily routine so that less dedicated time will need to be set aside for exercising.

Schedule exercise sessions into your week as appointments that cannot be broken.

Use discontinuous exercise – break up your workout into smaller segments over the course of the day.

Set up a personal reward system for your achievements, particularly for frequency of exercise sessions – this is especially important for the three to six months it takes to establish a lifelong habit.

Strength Training’s Mental Health Benefits

Tuesday, October 1, 2013 - 14:45

Many of the benefits of strength training have gradually become more widely known over the past few years. The ability of this form of exercise to maintain or increase bone density, reduce the risk of musculoskeletal injuries, increase stamina, improve blood lipid profiles, enhance glucose metabolism and insulin sensitivity, improve body composition, lower blood pressure, correct posture, and improve functional capacity for people of all ages including the elderly is gradually moving outside the realm of academic knowledge into the mainstream. When it comes to exercise and mental health, the common perception is that aerobic exercise like walking, running or cycling is beneficial. However, recent studies are demonstrating more and more that strength training also has the miraculous power to transform mood.

Anxiety

Anxiety is a very common problem that affects approximately 15% of the population with symptoms that last anywhere from 15-30 days per month. Anxiety can range from a minor annoyance to debilitating. It is manifested in feelings of nervousness, fear, apprehension and worry. Short term anxiety related to specific events, such as a test or new challenge at work, is normal. However, prolonged symptoms can lead to sleep disruptions, mental distress, body pain, poor health, and limitations to physical activity. Strength training can improve the symptoms of anxiety – and interestingly, several studies have found that moderate intensity resistance training is more effective than high intensity in this regard.

Cognition

Cognition is the ability of the brain to absorb knowledge through thought, experience and senses. Executive function, seated in the prefrontal cortex, is the part of the brain that is responsible for the higher level cognitive processes of organization, sequencing, time management, working memory, and task completion. Of note is that poor executive function is the hallmark of the common affliction ADHD (Attention Deficit Hyperactivity Disorder), which affects both children and adults. Without proper executive function, a person is unable to transform great ideas into a cogent piece of written work, or even plan an itinerary for a trip. Executive function, as with other facets of cognition, tend to decline with age. A great amount of research looking at older adults has been undertaken, and it has been shown that strength training improves several aspects of cognition on older people. This is most vivid with respect to memory related tasks. Additionally, major improvements in executive function have been elicited with resistance training and cardiovascular training alike.

Depression

Depression is not occasionally sadness – it is prolonged feelings of hopelessness and helplessness, which results in mood disturbances, fatigue, lack of motivation, insomnia or excessive sleep, restlessness, agitation, and/or body weight fluctuations. Although the results of studies on resistance training and mild depression are mixed – some show benefit, some do not – studies on clinical depression demonstrate marked improvement in symptoms. Strength training for mild depression may be helpful, but it is possible that the optimal dose has not yet been established.

Self-Esteem

Self-esteem is a person’s opinion of him/herself, and is related to self-worth, self-respect, and self-integrity. High self-esteem is strongly associated with positive physical and mental well-being. Resistance training has unequivocally been shown to improve self-esteem in healthy adults of all ages, in populations with cancer and depression, and in people undergoing cardiac rehabilitation.

Sleep

Ahhh, sleep. We spend 30% of our lives sleeping – at least we are supposed to! – and insufficient sleep is detrimental to our physical and mental health. Consistent sleep deprivation of less than 6 hours a night is associated with cognitive impairment, mental illness, hypertension, obesity, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents, and a diminished quality of life. The literature to date reveals that physically active individuals usually have healthy sleep patterns and a lower risk for sleep apnea. Moreover, depressed individuals with sleep disorders show a 30% improvement in sleep from a regular resistance training intervention. These results tend to appear after 8-10 weeks of consistent resistance training.

Exercise Specialist Recommendations

My advice is quite simple – start to strength train. However, this comes with several caveats:

Start very slowly, with at least 24 hours in between workouts.

Consult with an exercise professional – one with a well-regarded certification from an externally accredited organization like ACE or NSCA – for a well-designed program that takes any limitations or challenges into account.

Focus initially on core stabilization, which will help you avoid injury.

Do NOT adopt a program you see in a magazine!

Focus on proper form and technique – a professional can help with this.

Learn how to stretch properly also – and stretch after your strength training workout.

Enjoy the process of becoming strong and more capable!

It’s NEAT: Burn Calories Without Exercise

Monday, July 8, 2013 - 16:00

As obesity in both children and adults continues to be a serious personal and public health issue, the need to recognize all contributing factors becomes even more important. Inactive lifestyle and low levels of structured exercise, coupled with excessive food intake, are commonalities observed among a majority of overweight/obese individuals. Over the last decade, an innovative field of study has developed which looks how activities of daily living, called non-exercise activity thermogenesis (NEAT) impact on weight gain and obesity. NEAT is the energy expenditure that occurs during daily activities that are not considered planned exercise, including standing, walking, talking, and fidgeting. This body of literature grew from the observation that people who fidget and move around a lot in their everyday lives – individuals who “can’t seem to sit still” – tend to not be overweight.

In a 2005 study, researchers recruited 20 healthy volunteers who had one very similar description of their planned physical activity – they did none. They were self-proclaimed “couch potatoes”. Of the 20 volunteers, 10 were classified as lean on the Body Mass Index scale, and 10 were classified as mildly obese. The authors selected mildly obese subjects because this group is less likely to have medical impediments and orthopaedic issues than the morbidly obese. Each individual wore an inclinometer and triaxial accelerometer, sensitive monitoring devices that capture data on body position through all planes of movement 120 times per minute. With this equipment, the authors were able to capture data every half-second for 10 days, leading to an incredible final collection of 25 million data points on movement and posture for each subject after the 10-day experiment was completed.

The results were striking: the obese subjects were seated for 164 minutes longer each day than the lean subjects. In addition, the lean participants were upright for 152 minutes longer per day than the obese subjects. Sleep times between the groups did not vary at all. In essence, the energy expenditure generated by the lean individuals’ extra movement averaged 352 calories per day, which is equivalent to approximately 36.5 pounds per year.